| NPI | 1619128634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60680701) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA SC60113634) |
| 101YM0800X Counselor, Mental Health (Licence: WA LW60296750) | |
| Enumeration Date | 2008-10-08 |
| Last Update Date | 2016-09-02 |